Distraction osteogenesis in Pierre Robin sequence and related respiratory problems in children

Introduction: Sleep apnea is one of the most frequent manifestations of respiratory obstruction. Historically this clinical entity has stimulated the production of numerous valuable contributions with one purpose in mind: the improvement of airway permeability. A multi-disciplinary approach is required to define the problem in anatomic and functional terms to avoid a traqueostomy and prevent long-term sequels. We decided on an approach that focuses on improving the projection of the tongue in the posterior pharynx; by lengthening the mandible and bringing the muscular insertions of the floor of the mouth forward, the antero-posterior dimensions of the airway are increased. Objective: To evaluate mandibular distraction osteogenesis as a simple mandibular lenghtening procedure useful as a definite treatment in patients with obstructive sleep apnea. Material and Methods: The series consisted of 15 consecutive patients, divided in four groups. Patients with acute upper airway obstruction who required endotraqueal intubation, patients with no acute upper airway obstruction but with severe respiratory distress, patients with milder degrees of airway obstruction, and patients with long-term traqueostomies. Therapeutic interventions were performed according to the findings of each group. Results: The patients were evaluated according to cephalometric analysis, polysomnograms, nasopharyngoscopy, and clinical data. Significant changes were seen in the cephalometric studies. There were no postoperative episodes of apnea; clinical improvement occurred in all patients and decannulation was possible in all patients. Conclusion: Mandibular distraction is a safe and reliable procedure for treating patients with obstructive sleep apnea.